Endoscopic Diagnosis of Pediatric Acute Gastrointestinal Graft‐Versus‐Host Disease

Abstract

Rectosigmoid and combined upper endoscopic biopsies are equally sensitive for the diagnosis of acute GI GVHD in children. Flexible sigmoidoscopy can be done unsedated in appropriate patients at the bedside without anesthesia; it can be performed first to identify GI GVHD.

Diagnostic accuracy of endoscopic features of pediatric acute gastrointestinal graft‐versus‐host disease

“…Several authors argue that endoscopic evaluation of the terminal ileum is not necessarily important for diagnosing acute GI‐GVHD because their studies showed that rectosigmoid biopsy diagnosed GI‐GVHD with high sensitivity. However, the terminal ileum was not well evaluated in previous studies . In our study, we showed that the diagnostic features in the colon were found more frequently on the left side of the colon of patients with acute GI‐GVHD, similar to previous reports .…”

“…One was the study of Sultan et al. who assessed the frequencies of positive endoscopic findings in 40 children (<18 years of age) with GI‐GVHD and eight children who were classified as non‐GVHD . The most common endoscopic findings in the pediatric patients with GI‐GVHD were normal mucosa in the stomach, duodenum, and rectosigmoid colon, but significant findings between the two groups were not detected.…”

Rectal biopsy, rather than ileal, is appropriate to confirm the diagnosis of early gastrointestinal graft-versus-host disease

“…However, these are older reports in which the final diagnosis was made later in the disease process [20]. By contrast, recent reports showed no relationships between mucosal injury severity and the diagnostic rate of pathological GI-GVHD [12,13,22]. These reports may support our present findings of no clear association between endoscopic mucosal injuries and GVHD manifestations.…”

Hematopoietic Stem Cell Transplantation

“…46 Both procedures can be performed simultaneously or in some instances in isolation if the GI symptoms suggest a localized process (diarrhea vs. nausea and vomiting). 46 Both procedures can be performed simultaneously or in some instances in isolation if the GI symptoms suggest a localized process (diarrhea vs. nausea and vomiting).…”